Recognition of disease is the first step in quality care for type 2 diabetes. One-third of diabetes in the United States is undiagnosed. Rates for undiagnosed diabetes have been historically higher in non-whites and in men. The natural history of type 2 diabetes includes a relatively asymptomatic preclinical phase, which has been estimated to last 10-12 years. Many patients are diagnosed only after the clinical symptoms and signs become manifest. Some groups of patients may have delays in diagnosis based on such factors as minority race, low income, low level of education, and lack of health insurance. Furthermore, these delays may lead to type 2 diabetes microvascular complications such as neuropathy and nephropathy, as well as macrovascular complications such as coronary artery disease and lower extremity vascular disease which are already present at the time of diagnosis of type 2 diabetes. The Office of Disease Prevention and Health Promotion has identified the establishment of a National Diabetes Detection Program as a priority. Knowledge of the factors that affect diagnosis of type 2 diabetes and of the consequences of undiagnosed type 2 diabetes will help clinicians and policy makers optimize our approach to diabetes care. This will result in improved recognition of type 2 diabetes, as well as preventive strategies aimed at slowing the accelerated cardiovascular morbidity and mortality associated with type 2 diabetes. We will investigate these factors over the next 2 years using the nationally representative sample present in the National Health and Nutrition Examination and Survey 1999-2000 (NHANES). [unreadable] [unreadable] [unreadable]